Session “Workloads, Work Organisation
and Staffing Levels”
Summary Info: EPSU’s Ongoing Work on
Safe and Effective Staffing Levels
EPSU Conference on
Collective Bargaining and Social Dialogue
10 & 11 January 2017
Mathias Maucher
Policy Officer „Health and Social Services”
European Federation of Public Service Unions (EPSU)
Brussels
Health worker staffing is considered safe and effective when
it results in the recruitment, assignment and retention of
a health workforce of sufficient quantity and quality to
create positive impacts for patients and the organisation’s
effectiveness, delivered within a context of decent work.
(Lawless and Lowe, 2015)
Safe and effective health worker staffing levels:
What are we talking about exactly?
Jane Lawless, EPSU, Brussels, June 2015 ©
Patient Agenda
To have health needs met
Employer Agenda
Efficient & productive
investment of resources
Shared Agenda
Health needs are met while
making efficient & productive use of resources & in
the context of sustainable, decent work
Workforce Agenda
Sustainable, decent work
Professional
Organisations
Trade
Unions
Common and distinct agendas/priorities on SESL & Role of TU
Jane Lawless, EPSU, Brussels, June 2015 ©
Objectives of EPSU’s work on safe and effective staffing levels
• Policy objectives and priorities (WP SC HSS 2015-2016)
o Promote the definition and application of staff-patient-
ratios and mechanisms for the forecasting and calculation of
needs for certain categories of staff
o Cooperate with PSI and its affiliates
• What can/should EPSU do?
o Collecting information on methods for the calculation and
definition of adequate and safe staffing levels in order to
ensure the proper functioning of health and social care
institutions/services and specific departments
o Elaborating a report with the aim to facilitate the exchange on
experiences, good practice and trade union actions/strategies
o Input of national experiences and recommendations of
EPSU in EU-level debates (e.g. on workforce planning or
skills mix/task shifts or in the context of the SSDC HS)
Jane Lawless, UNISON, Cardiff, March 2016 ©
Nurse-staff ratios / Patients to total staff ratios in EU and USA
Source: RN4CAST Study
Percent Nurses Reporting Too Few Staff to Provide Quality Care
84
49
80 78
68
85 77
68 59
83
63
76
63
0
10
20
30
40
50
60
70
80
90P
erc
ent A
gre
e
Too few staff to get the work done
Jane Lawless, UNISON, Cardiff, March 2016 ©
Source: RN4CAST Study
Ver.di/EPSU Seminar SESL 16.11.16 Berlin: FIN: RAFAELA®
Legislation with enforceability
Enterprise agreement with enforceability
Legislation without enforceability
Enterprise agreement without
enforceability
Guideline
Professional Consensus
Customary Practice
Jane Lawless, UNISON, Cardiff, March 2016 ©
UK: England
UK: Wales
NZL
Norway
AUS: Victoria USA: California
Types of SESL systems (ordered by levels of enforceability)
Expected positive impacts of safe and effective staffing provisions
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Positive effects
Source: Survey EPSU Affiliates HSS (10-11/2016); nmax=18
Ver.di/EPSU Seminar SESL 16.11.16 Berlin: Let’s Use TU Power
Jane Lawless, UNISON, Cardiff, March 2016 ©
Different types of TU activities in relation to SESL & „Outcomes“
• Actively working to build interest in the safe and effective
staffing agenda for trade unions and workers [nmax=18; TU active
and … successful: 30%; mixed results: 60%; not successful: 10%]
• Doing surveys with the own members or research on issues
relating to with staffing levels/needs [40%;50%;10%]
• Working on or being involved in determining methods to
calculate staffing levels or nurse-patient ratios for units,
departments or services [75%;25%;0%]
• Undertaking activities to influence the conditions for
successfully establishing staffing levels (at enterprise or
political level) [70%;10%;10%; not active: 10%]
• Making efforts to secure staffing levels via mandated systems
or provisions offering protections (e.g. capacity to close
beds/reduce services when understaffed) [15%;65%;20%]
• Including the safe and effective staffing agenda as a core and
ongoing work stream in our organisation [60%;30%;10%] Source: Survey EPSU Affiliates HSS (10-11/2016); nmax=18
On the way to/defending mandated SESL: TU Action in AUS
Jane Lawless, UNISON, Cardiff, March 2016 ©
Staffing system needs to be simple to promote & understand
Playing the long game (but know where the end is)
Create windows of opportunity & are ready to use them
Staffing is an integral, permanent union strategy
Staffing used as an organising tool
Staffing is uncoupled from other terms & conditions (especially wages)
Speak with one voice
Refusal to compromise on the essentials
Know when to defend & when to push change
Hope & positivity
Use evidence & statistics to advantage
Influence the public and politicians
Establish a system difficult to attack Jane Lawless, UNISON, Cardiff, March 2016 ©
SESL arrangements: TU as key actors and TU controlling the narrative (ex. AUS)
PSI-UNISON Workshop SESL (12 May 2015): Conclusions
• The case studies demonstrated a wide range of methodological approaches to staffing. It was clear that the most durable were based on mandated nurse-to-patient ratios. Whereas there is no ‘one-size fits all’ methodology, trade unions must be able to critique prospective or existing methodologies to establish that they are fit-for-purpose.
• Local differences in workforce models, care models and funding models mean that local staffing solutions are required. Regardless of local variance, however, the staffing methodology must perform its basic purpose which is to match the health worker resource provided to patient demand.
• A ratios-based approach is the best option, recognizing that the ratio must take account of numbers, skill mix and workforce distribution, be developed to be as sensitive as possible in application, and vary to reflect local differences.
• Whatever system is arrived at, it must be simple in application, mandated, and protected. The impact of the system on patients, staff and productivity should be observable and observed. Accountability based on monitoring for enforcement is paramount. Jane Lawless, EPSU, Brussels, June 2015 ©
Links to other topics and risks for TU as to work on SESL agenda
• Links from the SESL agenda to other topics important for EPSU
o Occupational safety and health/well-being at the workplace
(e.g. linked to prevention and reduction of musculoskeletal
disorders or to psycho-social risks and stress at the workplace)
o Effective workforce recruitment and retention measures
o Qualifications/skills/competences, skills mix, task shifts
o Access to continuing professional development
o Sustainable funding & mechanisms of financing in health care
systems (e.g. DRG; not appropriately „covering“ care work)
o TU organising and recruitment and retention of members
• Risks for TU as to work on SESL agenda
o Usefulness of SESL in the context of restructuration processes
(e.g. when outsourcing non-medical services; “core team” = ?)
o Impact of method applied to measure the care “needed”
o Professions in focus vs. how to include all (care) workers?
Thank you for
your interest and attention!
Links for further information
EPSU
http://www.epsu.org/
Health and Social Services http://www.epsu.org/sectors/health-and-social-services-0
Social Services http://www.epsu.org/nl/search/sectors/health-and-social-services/policies/social-services
European Social Dialogue Hospital/Health Care Sector http://www.epsu.org/nl/search/sectors/health-and-social-services/policies/social-dialogue
EPSU Newsletter http://www.epsu.org/epsu/news-room/newsletter
Collective Bargaining Newsletter http://www.epsu.org/search/type/epsucob_article
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